VIST PREFERRED PRACTICE PATTERNS 1.0 VISUAL IMPAIRMENT SERVICES TEAM (VIST) 1.1 VIST REVIEW 1.1.1 DEFINITION OF PROCEDURES Formal review procedures are completed including but not limited to: 1) Eye exam 2) Complete History and Physical Examination 3) Hearing Evaluation 4) Review of benefits, services and adjustment to blindness 1.1.2 WHO PERFORMS Members of the VIS Team or designated health care providers. 1.1.3 EXPECTED OUTCOMES The VIST Coordinator will obtain documentation of the veteran’s status of legal blindness. The VIS Team and/or VIST Coordinator will determine needs for blind aids and prosthetic equipment related to sight loss. The VIS Team assessment will include patient history, current skill levels, adjustment to blindness and current needs. It will result in a description of the veteran’s functional capabilities and limitations. The VIST Coordinator will develop a treatment plan which will include recommendations for other examinations, services and follow-up as indicated. The VIST Coordinator will inform each veteran of the full range of services for which he/she is eligible. Veterans and/or their caregivers will be able to identify and access national and community resources essential to enhancing their involvement in the home and community. 1.1.4 CLINICAL INDICATION FOR PROCEDURE Upon referral, legally blind veterans are assessed for VIST services. 1.1.5 CLINICAL PROCESS Each veteran legally blind veteran will be invited to participate in a review of VIST services. Each VIST eligible veteran will be invited to participate in an annual review. A review of the veteran's medical records will be completed by the appropriate VIS Team member. The review components are to be offered at VA facilities and arranged by the VIST Coordinator. VIST medical exams will be conducted by assigned medical staff. All VIST medical exams will routinely include cholesterol, diabetes, and colo-rectal cancer screening and other tests as indicated. VIST exams should contain the required elements for blind rehabilitation referrals whenever possible. VIST eye exams will be conducted by assigned eye care professionals to assist in determining legal blindness. The exam will include best corrected central visual acuities and, when indicated, visual field testing will be conducted using a Goldmann III4e target. VIST hearing exams will be conducted by assigned audiology professionals to determine whether or not the veteran would benefit from hearing aids. 1.1.6 SETTING All elements of the VIST review will offered at a VA facility. 1.1.7 DOCUMENTATION Documentation contains assessment results, veteran's goals, and specific recommendations. Recommendations may address the need for further assessment, follow up or referral. Results will be recorded in the medical record. The VA Record 10-1371, or an electronic equivalent, will be completed and filed on each veteran. 1.1.8 PROFESSIONAL POLICY AND RELATED REFERENCES M-2, Part XXIII VIST Desk Reference Manual, Volumes 1-3. VIST PREFERRED PRACTICE PATTERNS 2.0 VISUAL IMPAIRMENT SERVICES TEAM (VIST) 2.1 VIST REFERRAL FOR VA BLIND REHABILITATION TRAINING 2.1.1 DEFINITION OF PROCEDURES Formal referral procedures for VA Blind Rehabilitation are completed. 2.1.2 WHO PERFORMS VIS Team Coordinator and appropriate Team members. 2.1.3 EXPECTED OUTCOMES The VIST Coordinator will inform veterans of the full range of services and opportunities provided at VA blind rehabilitation facilities. Eligible blinded veterans will be encouraged and motivated by the VIS Team to apply and participate in VA blind rehabilitation programs. All required evaluations and examinations will be completed in a timely manner (not to exceed 6 months prior to the date of application). The VIST assessment will include in a description of the veteran’s functional capabilities and limitations. BRC applications will be completed for those veterans expressing a desire to participate in a VA blind rehabilitation program. 2.1.4 CLINICAL INDICATION FOR PROCEDURE Eligible veteran’s expressing an interest in blind rehabilitation. 2.1.5 CLINICAL PROCESS During the VIST Review evaluation, blinded veterans will be counseled and assessed as to the need for blind rehabilitation training. Blinded veterans should be encouraged and motivated to explore the benefits of blind rehabilitation by the VIS Team. 2.1.6 SETTING VA facility 2.1.7 DOCUMENTATION Documentation contains required VA forms, clinical evaluations, assessments and specific recommendations by VIS Team members and other healthcare providers. It will also include the veteran's goals. Recommendations may address the need for BRC program modifications to meet special needs of applicants. Appropriate documentation will be recorded in the medical record. The VA Record 10-1371, or an electronic equivalent, will be updated to reflect the status of the referral. 2.1.8 PROFESSIONAL POLICY AND RELATED REFERENCES M-2, Part XXIII VIST Desk Reference Manual, Vol. 3. VIST PREFERRED PRACTICE PATTERNS 3.0 VISUAL IMPAIRMENT SERVICES TEAM (VIST) 3.1 REVIEW OF BENEFITS & SERVICES 3.1.1 DEFINITION OF PROCEDURES Blinded veterans will be offered an annual review for VA and blindness related benefits and services for which they are eligible. 3.1.2 WHO PERFORMS VIST Coordinator, VIS Team members and designated staff. 3.1.3 EXPECTED OUTCOMES Veterans and/or their caregivers completing a VIST Review will be aware of all VA and blindness related services for which they are eligible. VIST will assist veterans in obtaining additional information, benefits and/or services for which they are eligible. The VIST Coordinator will inform veterans of the full range of services and opportunities provided at VA blind rehabilitation facilities. 3.1.4 CLINICAL INDICATION FOR PROCEDURE Veterans participating in a VIST Review or those veterans who express an interest in receiving benefits and services available for the blind. 3.1.5 CLINICAL PROCESS Based on the results of the VIST Review evaluations, blinded veterans will be counseled and educated concerning all VA and non-VA blindness related benefits and services for which they are eligible. VIST will provide assistance and guidance in helping veteran’s receive desired services and/or benefits for which they is eligible. 3.1.6 SETTING VA facility 3.1.7 DOCUMENTATION The medical record and or the VIST file will be updated to reflect the veteran’s status for all VA and blindness related services and benefits. Comprehensive rating data needs to be updated on VA Record 10-1371, or an equivalent electronic record. 3.1.8 PROFESSIONAL POLICY AND RELATED REFERENCES M-2, Part XXIII VIST Desk Reference Manual, Volumes 1-4. VIST PREFERRED PRACTICE PATTERNS 4.0 VISUAL IMPAIRMENT SERVICES TEAM (VIST) 4.1 EDUCATION & TRAINING OF VA STAFF 4.1.1 DEFINITION OF PROCEDURES VIST will provide initial and ongoing education and training on VIST and blindness to VA staff and volunteers. 4.1.2 WHO PERFORMS VIS Team Coordinator and appropriate Team members. 4.1.3 EXPECTED OUTCOMES Increased awareness of VIST and BRS services among VA staff. Increased referral of blinded veterans to VIST. Improved care and service to blinded veterans in VA facilities. 4.1.4 CLINICAL INDICATION FOR PROCEDURE All VA clinical and administrative personnel who may come in contact with blinded veterans. 4.1.5 CLINICAL PROCESS VIST will arrange and conduct in-service educational programs on VIST and blindness. VIST would target key clinical or administrative services that may have an impact on blinded veterans. 4.1.6 SETTING/EQUIPMENT SPECIFICATIONS Educational programs will take place in VA facilities. Demonstration devices may include: Vision simulators Audio-visual equipment Canes Watches Low vision aids Other appropriate prosthetic devices. VIST should also develop and maintain educational material, including: brochures, posters, handouts, etc. 4.1.7 DOCUMENTATION VIST will maintain a record of in-service and educational programs conducted during the fiscal year. In-service and educational programs will be documented in the VIST Annual Narrative Report. 4.1.8 PROFESSIONAL POLICY AND RELATED REFERENCES M-2, Part XXIII VIST Desk Reference Manual, Volumes 1 and 4.